Development of a Homemade Spinal Model for Simulation to Teach Ultrasound Guidance for Lumbar Puncture
Spinal procedures such as lumbar punctures (LPs), epidurals, and spinal blocks are essential components to clinical practice but are challenging to teach, learn, or practice on real patients due to patient safety and comfort limiting the number of attempts. Resident physicians traditionally learn these spinal procedural skills through observation of a more senior physician before attempting the procedure. Simulation using models can improve providers’ competency without introducing an added risk to patients. A difficulty encountered with access to simulation training for such procedures is the limited availability of simulators. While there are several high-quality, commercially available models that mimic the anatomy of lumbar spine, the cost of these models often limits the access to students and practitioners. The other challenge is access to simulators with versatility that can be used for palpation as well as ultrasound (US)-guided procedures. A simulator that can combine practice of both palpation and US-guided modalities would be efficacious in reducing cost to the teaching institutions. We attempted to overcome the access barrier to spinal models by developing an alternative that provides a good simulator for both palpation and US-guided LP while keeping the cost low. Our model can be easily manufactured by not only clinicians but also medical students.
A literature review was conducted to assess the available research and information on the production and use of simulators for practicing LPs and other spinal procedures. Publications queried described the production of models and utilizing the information compiled we devised and fabricated a model.
A lumbar spine model was developed using computed tomography spine data of an average-sized male patient without lumbar spine pathology. The model was created using medical imaging processing software and printed on 3D printer using nylon plastic. This model was then utilized by residents, advanced practice providers, and medical students for palpation and US-guided LP simulation training.
An inexpensive reusable non-commercial LP simulator can be an effective method for teaching invasive procedures like LPs, especially if it can be used both for palpation and US-guided procedures. The method outlined here can be easily reproduced in a relatively short amount of time. We recognize one limitation in the widespread dissemination of this technique being access to a 3D printer and digital designs for printing. Future studies will be necessary to determine the efficacy of the homemade LP simulator in teaching neurointensivist in training.
KeywordsLumbar puncture Ultrasonography Education Simulation training Phantoms Imaging Point-of-care systems Models Anatomic
We would like to acknowledge Dr. Candace Curry for building us the wooden frames in her woodworking workshop, Dr. Sonum Bharill for being the human spine comparison, and Dr. Casey Glass in inspiring us to create non-commercial simulators through his leadership at the Ultrasound Interest Group at Wake Forest School of Medicine. We would like to acknowledge multiple providers who were willing to try and test our attempt at homemade simulators.
All authors listed were responsible for contributions to conception of the project and implementation of the model, drafting the article or revising it critically, and approved the final manuscript to be published.
Source of support
There was no support for this work.
Conflicts of Interest
The authors declare that they have no conflicts of interest.
Ethical approval/informed consent
During the course of this work, there was strict adherence to ethical guidelines. Informed consent was obtain from all survey respondants following insitutional guidelines.
- 5.CAE Healthcare. Lumbar puncture and spinal epidural training model. 2018. http://www.bluephantom.com/product/Lumbar-Puncture-and-Spinal-Epidural.aspx. Accessed 24 Jan 2018.
- 23.Clear Ballistics. Clear Ballistics. 2017. https://www.clearballistics.com/about/. Accessed 30 Apr 2019.
- 24.Cumberland Rubber Supply. Cumberland Rubber Supply (CRS)—Ballistic Gel. 2017. http://cumberlandrubber.com/gel.html. Accessed 30 Apr 2019.
- 25.Environmolds. 20% Clear Ballistic Gwl Blocks. 2017. https://www.artmolds.com/20-perecent-clear-ballistic-block.html. Accessed 30 Apr 2019.
- 26.Humimic Medical. Products—humimic medical. 2018. https://humimic.com/. Accessed 30 Apr 2019.
- 27.National Institutes of Health. NIH 3D Print Exchange. 2019. https://3dprint.nih.gov/. Accessed 30 Jan 2019.
- 30.Santronics Inc. How much does a 3D printer cost? 2019. https://www.makeshaper.com/3d-printer-cost/. Accessed 30 Jan 2019.
- 32.Ranellucci AL, Joseph. Slic3r–open source 3D printing toolbox. 2019. https://slic3r.org/. Accessed 30 Jan 30 2019.
- 34.Coordenaçāo do Laboratório Aberto e Parque Tecnológico. InVesalius home. 2017. https://www.cti.gov.br/en/invesalius. Accessed 30 Jan 2019.
- 35.MakerBot Industries LLC. Thingverse. 2019. https://www.thingiverse.com/. Accessed 30 Jan 2019.
- 36.Embodi3D LLC. Embodi3D Downloads. 2019. https://www.embodi3d.com/files/. Accesse 30 Jan 2019.